Going above and beyond

Donna Sollenberger, EVP & CEO, UTMB Health SystemYesterday, I received a letter from one of our patients, and I wanted to share it with you all today, because I think it is a wonderful example of how when we do just a little more than is required for our patients, and we do so genuinely, we lift them up. Going the extra mile for our patients doesn’t always require being faced with a patient who has dramatic needs or challenges. Sometimes we can demonstrate care for our patients through a simple act of kindness or comfort, or finding a way to make the patient’s experience and process of care as convenient as possible for them. That’s exactly what happened in this case, and it helped make one of our patients feel truly cared for:

I am writing this letter to recognize the outstanding service that I received on March 21st and March 22nd from two of your employees. I had a doctor’s appointment at the Harborside Medical Group office and came in contact with Alina Valdez. When I arrived and checked in, the first receptionist could not get my parking ticket validated. She handed it off to Alina and after 10 attempts she was able to obtain a validation code.

After I finished my appointment with my physician at approximately 5:20 p.m., I went back to the reception area and the only one there was Alina. I told her the doctor ordered an X-ray and that I would need to make an appointment (I knew it was after 5:00 p.m.). Alina explained that she could get me over to the main hospital; she knew that Olivia Martinez in Radiology also stays late, and they could get my X-ray done that day so I wouldn’t have to make another trip or visit. I also needed to make another appointment to see a specialist, which Alina handled, scheduling my appointment for the next day at 11:00 a.m.

Alina made several follow-up calls and kept me informed. It is my belief that Alina went out of her way to assist and accommodate me for no reason other than I was a patient, and Olivia also was very helpful. They didn’t have to be.

I would greatly appreciate someone recognizing these two ladies for their care and dedication to both UTMB and me as a patient. I am truly impressed and know the value of dedicated employees. Please know that I am very appreciative of their service.

When we treat each patient the same way we would want to be treated, or as we would want a valued member of our family to be treated, not only are we doing what is right, but we are also distinguishing the patient experience at UTMB from all other providers. When we warmly greet and assist patients and visitors, and we find solutions for them, we show them that we respect them as human beings and we understand their time is valuable. When we work together to make sure the patient gets the test or appointment they need in a timely manner, we show that we care about their well-being. We can demonstrate care and respect by promptly responding to patients’ messages. We can follow up with them to make sure they are satisfied with their experience and that they have all the information they need.

When we consistently deliver an exceptionally good patient experience, and when we thank our patients and families for choosing UTMB, we set ourselves apart from the rest. Let’s be the kind of UTMB Health employee that always represents the kind of care we say we will deliver—the same care we would want for the most cherished of our loved ones. Going above and beyond is what providing excellent care and service is all about!

How do you go the extra mile for our patients?

The power of focus – keep your eyes on the prize

Donna Sollenberger, EVP & CEO, UTMB Health SystemJimmy Johnson is an American football broadcaster and former player, coach and executive. His coaching career was incredible. He was the first and one of only three football coaches to lead teams to both a major college football championship and a Super Bowl. He is also one of only six men in NFL history to coach consecutive Super Bowl winners (for inquiring minds, the others included Vince Lombardi, Don Shula, Chuck Noll, Mike Shanahan, and Bill Belichick).

In Johnson’s first year as coach of the Dallas Cowboys (1989), the team had a terrible season. Johnson, however, did not take long to develop the Cowboys into a championship-quality team. Once, before a game they needed to win to keep their season alive, he told the Cowboys a motivational story:

“I told them that if I laid a two-by four plank across the room, everybody there would walk across it and not fall, because our focus would be that we were going to walk that two-by-four. But if I put that same two-by-four plank 10 stories high between two buildings, only a few would make it, because the focus would be on failing. Focus is everything. The team that is more focused today is the team that will win this game.”

Johnson told his team not to be distracted by the crowd, the media, or the possibility of losing, but to focus on each play of the game itself, just as if it were a good practice session. The Cowboys won the game, 52-17.

Last week in my post, I talked about how, when we began the Best Care initiative, many people expressed to me that our goals for Best Care were too far of a stretch and it would be a highly unlikely feat. Yet, after I reviewed the second-quarter results of Best Care, I feel as confident as ever that if we maintain our focus, we will be successful. So far, we have really improved in almost all areas. It is true, we slipped slightly in our 30-day readmissions goal at the close of the second quarter, but our six-month overall performance still meets the goal. We just need a lot of focus in this area as we head into the third quarter. We also saw a spike in our second major safety measure, the Central Line-Associated Blood Stream Infection (CLABSI) Standardized Infection Ratio (SRI). While the reasons for this spike are partially due to surveillance definitions that affect all measured organizations, we have implemented improvement processes where appropriate, and we expect to improve in the next quarter for this goal, also.

Overall, when I look at our performance for the first two quarters, I see we are trending in the right direction. This made me think about how “overnight success” is a myth. Success is a journey that sometimes comes with setbacks and adversity. Most successful people throughout history dedicated years to learning and perfecting their craft, during which they experienced disappointment, reinvention and, finally, success. Most experienced periods of trial and error. The one thing successful people (and organizations) have in common is that they know in order to accomplish their goals and to be successful, staying focused is critical.

I think when you’re working as hard on something as we have been toward Best Care, when there is any area in which one’s performance isn’t quite as good as one had hoped, there is a naturally tendency to get stuck on the negative and think about all of the losses for the day. But, it is important to also count all of one’s wins and find all of the good that took place. We should be very proud of the progress we have made.

Best Care is a journey, and we are learning as we go. It takes time to make some of the improvements we need. For example, common causes for readmissions nationally involve medications—sometimes patients are on high-risk medications like anticoagulants (blood thinners) or are on a high number of medications (polypharmacy). We will now have a pharmacist on board who will be dedicated to helping us with these issues so our patients are not readmitted. We also will continue looking for ways to find resources for our patients once they are discharged from the hospital. And, we will continue working on our processes to assure our patients have follow-up clinic appointments once they are discharged from the hospital.

I shared a parable once several years ago that tells of three stone cutters who were asked what they were doing. The first replied, “I am making a living.” The second kept on chiseling while he said, “I am doing the best job of stone-cutting in the entire country.” The third one looked up with a visionary gleam in his eyes and said, “I am building a cathedral.”

Are we all truly focused on Best Care—our cathedral of sorts?

Working on Best Care is our long-range goal. It will require focus, determination and exceptional teamwork. There will be times when we may feel like quitting, but that is absolutely the time we need to strengthen our resolve and remember why we started this work—for our patients to receive Best Care, every time and in every interaction.

We are halfway through the fiscal year, and we have made tremendous progress. If we stay focused on doing what’s right for our patients, I am confident we will achieve our goals by the end of August. Thank you for everything you are doing to assure that we achieve Best Care!

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Persistence is the twin sister of excellence

Donna Sollenberger, EVP & CEO, UTMB Health SystemWhen I was a sophomore in high school, my counselor signed me up for an advanced placement class: plane and solid geometry. I was excited because up to that point, school had been pretty easy for me. I was an overachiever (surprised?), and I wanted to take all of the classes I could that would prepare me well for college and make me a strong candidate for scholarships, which I really needed in order to attend.

I went to my first class. Mr. Gilmore was my teacher, a very nice man who seemed to explain the subject very well. However, each night when I got home and tried to do the homework, I could not do the problems. For some reason, the theory escaped me, and I received terrible homework grades those first few weeks.

One night as I sat at my kitchen table doing homework, I became visibly frustrated because I still could not do the homework problems. My dad came into the kitchen at the moment I was on the verge of tears. Dad was caught off guard by my display of emotion and wanted to know what the problem was. I told him about how I felt completely lost in the course, and that I didn’t think I belonged in it. I wanted to drop the class.

After several more nights of this, my dad became concerned enough that he called Mr. Gilmore. He told him that I was feeling very upset about the course. Mr. Gilmore reacted with what could be described as amusement. “Don’t worry,” Mr. Gilmore told my dad. “All of the students feel this way at this time in the class. In a few days, she will begin to understand it. It happens every year.”

As much as I didn’t want to, I stayed with the class. One day, the predicted happened—I finally understood plane and solid geometry and how to do the proofs! My grades improved dramatically, and I received A’s on my homework for the rest of the year.

Since that experience, I have often thought about how we react when things get tough or we are asked to do the seemingly impossible. Instead of buckling down and doubling the effort, we may be inclined to quit, believing our challenge is too difficult to tackle and accomplish.

I remember when we started the Best Care initiative last summer. Many people reacted with uncertainty and told me that our goals were not possible. After all, we had been trying for years to improve, and yet we were solidly stuck in the middle. How was this initiative going to be any different?

Today, I received the results from Quarter 2 of Best Care, and I am pleased to report that we have continued to improve in almost all areas. The results are as follows:

bestcare_q2summary3These are excellent results. While we still have much work to do as the upcoming quarterly targets will be more challenging, we are certainly on the right track. There may be moments in the coming months and weeks when you start to feel like we may not be able to continue improving to achieve our ultimate targets for the year; but, if you begin to think that way, just remember how far we have already come!

We were able to get through the first two quarters with excellent results, so I know we can continue performing well in the last two quarters. If we continue striving to deliver Best Care, we will reach our goal. When we do, it will be so wonderful for our patients and their loved ones!

There is a quote that says, “Persistence is the twin sister of excellence. One is a matter of quality; the other a matter of time.” To me, this describes our journey so far. Thank you for everything you are doing to help UTMB come this far toward achieving Best Care!

Seeing through our patient’s eyes

Donna Sollenberger, EVP & CEO, UTMB Health SystemSome of you will recall that I broke my leg almost two years ago. During that time, I was not allowed to put any weight on it, or my injury would have likely required surgery. During the 90 days I had to be completely off my leg, I really saw our Health System through the eyes of our patients, and that is something I hope you all try to do as you go about your work and travel throughout our facilities.

While I had many wonderful interactions during the time I was healing, and I received exceptional care at UTMB, I did experience one recurrent problem—many times, access to the patient pick-up and drop-off ramp was difficult to get to because employees’ rides or unattended vehicles were parked in front of the entrance. During that time, my husband always parked a bit down the road and waited for me to call him once I was on the ramp. But often, I still had to uncomfortably stand and wait on my crutches, holding my bags, because he couldn’t enter the ramp.

This comes to mind today, as I have noticed the ramp in front of Jennie Sealy Hospital has become increasingly congested lately—particularly during peak hours, like shift changes or the lunch hour. I have noticed multiple cars parked for up to a half hour in the lane intended for patient pick-up and drop-off, while our patients are forced to utilize the far left lane, which is meant for thru-traffic only. As a result, cars begin to pile up behind them, and as cars become trapped in the line, frustration mounts.

I think we all take it for granted when are able to easily move and get where we need to go, but navigating in a wheelchair or on crutches can be a lot of work, especially when you are in pain or not well, or you are being discharged and have other items to load into the vehicle. I couldn’t help but wonder what impression seeing our employees get into these vehicles must give our patients and their loved ones who are already stressed with getting their loved one in and out of the hospital or a clinic.

This may seem like a minor issue to some, but blocking the entrance for employee use does not communicate the message that we care about our patients’ and visitors’ needs. Since that experience, I have been passionate about assuring we have places where patients can be easily dropped off and picked up. I have asked people who are parked along the inside lane of the ramp who were waiting for employees to please exit and relocate to the lower right lane in front of Jennie, to help reduce traffic congestion on the ramp. I always ask politely and with a smile, but sometimes the responses I receive are not as polite. Nevertheless, I am committed to making sure our patients’ needs are met. At UTMB, we should always assure that the amenities intended for our patients’ convenience are readily available.

We have worked with Parking Operations and Facilities to help us in this matter. They have already painted the driveway curbs and labeled them to indicate that the right lane is for patient drop-off only and the left lane is for thru-traffic only. We also have designated a small group of 20-minute parking spaces on the east end of the building for employees, their rides, or delivery vehicles to utilize.

Unattended vehicles are prohibited on the ramp, and towing will soon be enforced. But even when several cars are attended by the drivers, yet stay on the ramp for a half-hour or more, it quickly contributes to creating traffic congestion on the ramp. (There is more to come in the way of signage for the Jennie Sealy Hospital ramp to help drivers more easily recognize the rules of the ramp.)

Many of you have asked me what you can do to contribute to Best Care. This is a simple way to contribute. Use of the Jennie Sealy Hospital ramp and/or the John Sealy Hospital circle drive by our employees is not prohibited. For example, if you have mobility challenges, we certainly understand that you need to be dropped off or picked up at the front door. I am simply requesting that all employees please respect the convenience of our patients and their loved ones by asking the people who are dropping you off or picking you up to be aware of the flow of traffic on the ramp and when it is busy, to not park and wait for you on the ramp unless you are ready to be immediately picked up (especially during peak hours like the lunch hour or shift changes).

Thank you for your understanding and cooperation in this matter. There should be no hesitation on our part to make the UTMB experience better for our patients and their visitors! This is an easy way you can contribute to Best Care.

“Empathy is about standing in someone else’s shoes, feeling with his or her heart, seeing with his or her eyes…it makes the world a better place”  —Daniel H. Pink

When you can’t see the forest for the trees…

Donna Sollenberger, EVP & CEO, UTMB Health SystemThe evening before Valentine’s Day, my son, Brad, and his wife, Maureen, went out for a nice dinner at a small bistro in Coronado, California, which is a beautiful resort town near their home. As they were looking over the menu, Brad noticed flames suddenly flickering over the top of his menu. He put down his menu and looked across the table at Maureen, who was studying the bottom of her menu so carefully, she didn’t notice the top was dangling above the candle on the table and had caught on fire.

“Maureen, your menu!” Brad alerted her. She looked up, screamed and dropped her menu on the table, which then caught the table cloth on fire. The couples at nearby tables immediately grabbed their glasses of water to toss on the fire and extinguish the flames. Needless to say, I’m sure this was a Valentine’s Day Brad and Maureen will never forget!

Aside from sounding like a scene from a romantic comedy, this scenario made me think about how sometimes, we become so focused on something we are doing that we miss detecting something that’s rather obvious or unexpected (like your menu being on fire). Or, at other times, we can become so distracted by a single task or detail, we fail to look at the situation as a whole.

When it comes to being focused on a task, we commonly mean thinking about one thing while filtering out distractions. So, it makes sense that if you give your full attention to one task at a time rather than trying to do several things at once, you’ll have higher quality results. But in reality, we have all learned to function well while multitasking. In fact, we can even become overwhelmed at times by information, a load of projects, or technology to be used. Trying to focus on too many things at once can easily open the door to mistakes. As the Nobel Prize-winning economist Herbert Simon wrote, “Information consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention.”

There are a couple of big ways not being focused, whether on our environment or on a task at hand, can have an impact—like on Best Care, for example.

Here’s a possible scenario. Two boxes of medications are packaged very similarly. While trying to perform more than one task, like answering the phone, I might accidentally grab the wrong box, expecting that I have the correct one. After all, it’s a medicine I administer almost every day! That could be a costly mistake for my patient! Fortunately, we have a bar code medication administration system which, when used properly, can catch my error.

Here’s another example. I am having a pretty good day, but very busy. I am walking down the main corridor of Jennie Sealy Hospital and checking an email on my phone. While I am trying to also watch where I walk, I fail to notice the expression on the face of a distraught family member who is trying to find the intensive care unit to visit their loved one. Or, I may even simply pass someone who is lost and trying to get to their clinic appointment on time. Let’s put down our phones and focus on our surroundings when we are traveling throughout our campuses and health system complex. No matter what our role, we all have a job to do in assisting visitors and patients who may be lost or confused trying to navigate our large system of facilities. Some of you have asked me how you can help achieve Best Care. This is one way you can do that.

To err is human—we all are capable of missing details. That’s why realizing we are susceptible to filtering out incoming information in our environment is important. Because we work in a fast-paced, demanding environment, we must practice awareness and remain vigilant about the safety and quality of the care and service we deliver.

Here’s another perspective on our Best Care focus. There are different ways of thinking about Best Care—there are the simple things we can all do each and every day that contribute to a positive patient experience, some examples of which I described above. But there is also the technical side of the coin, where we are collecting different forms of data to understand and track our performance in delivering care. We collect information on the cost of care, and we also use clinical documentation to reflect how ill our patients were and to record the processes of care we used to treat them. Together, this information determines our ranking for certain quality measures, like mortality or efficiency. So, it is possible to be so focused on moving the needle—improving Best Care—that we could lose sight of the fact that the ultimate goal of it all is to always do the right thing for our patients. Best Care means we are honoring patient-centeredness and delivering on outcomes that matter to patients and their loved ones!

In closing, I’d like to share a short video. Please watch it and follow these instructions: In the video, there are two teams of three persons each, one dressed in black and the other in white, revolved around each other and passed basketballs to their teammates. Count the number of times the ball is passed among the players in white.

This was a study conducted in 1999 by psychologists Daniel Simons and Christopher Chabris. They discovered that consistently, about 50% of their study participants failed to notice the gorilla. Whether or not the individuals saw the gorilla was not an individual difference trait. And interestingly, those who did see the gorilla could not believe that others actually failed to see it!

It just goes to show the importance of “avoiding distractions, paying attention to what others might notice, remembering that looking is not the same as seeing, and realizing just because your eyes are open, it doesn’t mean you’re seeing something!”*

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*Mike Lyles, Quality Engineering Program Manager

Why tread water when you can float?

Donna Sollenberger, EVP & CEO, UTMB Health SystemAs you already know from some of my prior Friday Flash reports, my grandson, Jack, is a swimmer. However, he is also only 10 years old, so he can be somewhat forgetful or disorganized when it comes to swim practice.

I am not a swimmer, so I am always fascinated by what the swim team does at practice. I have learned from Jack that one of the techniques his coach uses to help the swimmers gain upper body strength is to hold a flotation device, called a pull buoy, between their legs while swimming. The buoy helps keep the swimmers’ legs stationary and afloat as they swim through the water. This is an extremely important part of training, because it helps the swimmer focus on their arm movements, which is particularly beneficial for a swimmer who does the butterfly and breast strokes, like Jack.

Two weekends ago, my daughter, Jack’s mother, and I were having dinner when she told me an amusing story. For about three practices in a row, Jack had forgotten his buoy. His coach was not happy when he arrived at the third practice without it. So, to make a point, the coach told Jack that if he forgot it again, she was going to tie his ankles together and make him do the exercise that way—it must have made a point, because he hasn’t forgotten his buoy since.

As I thought about the prospect of trying to swim with my ankles secured together without a buoy, I thought about how we sometimes make work harder for ourselves than it needs to be. There are times when we are confronted with challenges, but we don’t remember to use our “buoy” for support, be it our co-workers, technology or available equipment. For example, do we ask others for help when feel overwhelmed with too much work? I know it is sometimes hard to ask for help, yet it is sometimes the best thing we can do.

I had a chance to meet a nurse recently who has worked at UTMB for about five years. She came to UTMB from a competitor hospital up the freeway, so I asked her what attracted her to UTMB. She told me that she had worked here per diem while she was a full-time nurse at the other hospital, and she noticed in her shifts at UTMB that if she had two new patients to admit at once, the other nurses on the unit always checked with her to see if she needed help. She told me that never happened at her full-time job. So when there was a full time opening at UTMB, she decided to quit her job at the other hospital and work here. I asked her if she felt free to ask for help if she needed it, and she told me, “Absolutely.”

I admire this nurse. Instead of struggling under a spike in workload and trying to do the job alone, she asked for and accepted help. Just like my grandson, Jack, she had decided it was easier to accomplish her work with a buoy as her lifesaver rather than trying to do the job with her “ankles tied together.”

Here’s another example. Most of the time, we have technology available to help us do our work more precisely, but we opt to take a shortcut to save time and don’t use the technology that helps make our work easier or safer. Not too long ago, we implemented a bar code system to help make giving medication to our patients safer—the nurse scans the patient’s wrist band, and then scans the bar code on the medication packet. This technology is a “buoy” that helps assure that the nurse is giving the right medication to the right patient, at the correct dose at the right time. If any of these variables are not correct, the technology then alerts the nurse that if they continue, there could be an error. Using the system literally can be a lifesaver, because it reduces the likelihood of a medication error. Although this cannot eliminate medication errors entirely, nor can it replace the diligence and critical thinking of the nurse, it is safer way for UTMB to provide high quality care for our patients in environments that have frequent distractions and elevated levels of stress.

What buoys do you have in your job that make your work easier? Are you using all of the tools you have to assure you are being as effective in your job as possible? Do you offer help when you see others need it, too?

Health care is a fast-paced environment. Asking for help and using the tools designed to make our work more efficient and processes more reliable equates to safer patient care and a positive patient experience. And sometimes, we can really benefit from the skill and expertise of our teammates. Asking for help isn’t always easy. But, sometimes it’s downright essential!

Accept yourself, your strengths, your weaknesses, your truths, and know what tools you have to fulfill your purpose. –Steve Maraboli

Today, I will learn something new.

Donna Sollenberger, EVP & CEO, UTMB Health SystemI am left-handed—at pretty much everything. I write left-handed, and when I played softball, I pitched left-handed. The only thing I really can do with my right hand is iron, and that is because my right-handed mom always left the ironing board set up in the utility room the way she liked it, ready to turn on. (I was too lazy as a kid to unplug the iron, collapse the ironing board, turn it around and set it up again, so that is how I learned to iron.)

When I was in elementary school, we were taught to write in cursive. Our lessons began in fifth grade, and by sixth grade, we were to use cursive exclusively. I wrote as most left-handers do: my left hand bent at the wrist, pen on the paper, dragging my hand across the ink, often smudging it across the page. At least, that’s how I wrote until Miss Bell became my sixth-grade teacher…

I remember the first time we were practicing cursive in the classroom. Miss Bell walked toward my desk, watched me write and then said, “You will not pass handwriting in my class unless you learn to write so it appears you are right-handed.” She then proceeded to show me how to do that, which involved turning my paper the opposite way and then writing without bending my hand at the wrist. I was mortified as all of the kids in class watched me. I was struggling. It felt so foreign to try to write that way.

I spent the better part of three months working and working on doing something differently than I had learned to do it for an entire year. I have to admit, it was really challenging. However, once I got the hang of it, cursive writing became easier and easier. Over the years, I have had people tell me that my writing looks as if I am right-handed, and most people who have seen my handwriting are surprised that I am left-handed.

I recall this part of my life now because the other day, my husband took a note I had written down to the front desk at the condominium building where we live. He came back amused that the two ladies at the front desk had asked him if he wrote the note. He told them that he did not; his wife had written it. One of the ladies asked him if I had ever won any awards for hand-writing! Now, I was laughing!!

The memory of trying to change something I had done for months, which had now become habit, made me think of the changes we are having to make to achieve Best Care. At first, we heard the goal and thought it really wouldn’t be possible. However, we also know that failure is not an option. We even have the University of Texas System Chancellor urging us on, and most importantly, we have patients who depend on us to give them the Best Care, every encounter, every time. So, some of us have to change the way that we have approached patient care, sometimes for years.

But change we must. So we begin by trying a new approach, one that we believe will get us the results that we were not getting before. For example, the way physicians document in the medical record the care they have given to a patient and the way they describe the patient’s illness can be the difference between being rated as a very high-quality or lower-quality academic medical center. Many physicians are having to learn to document differently than they have for years. It is hard to make the change, yet it is necessary so that we are recognized appropriately for the work we are doing.

In other instances, people who were trained step-by-step on how to document in the Epic medical record (because following that particular process helps ensure we are adhering to the recommended processes of care and that we are capturing all of the information we need) are then sometimes told once they are on the unit, “Oh, there is a easier way. Just do it like this.” And before you know it, the trained behavior is left behind because “there is an easier way.” Unfortunately, the easy way may actually make things more complicated for others who have to use the record further down the line. We may make the change to make our own work easier, but as a consequence, we unintentionally make work harder for someone else.

Can you think of a time when someone changed how they did their work, and that made your job harder? That is why, as we change our system and learn new ways of doing things, we need to do our part according to the way the process was designed. If the process needs improvement, let’s work on that together. Changing just our part may actually make it unsafe for the patient somewhere else down the line.

So, just like I practiced and practiced my handwriting until what I was doing became a habit, we must practice the changes we need to make in order to help us achieve Best Care. Whether you work on the loading dock, run blood tests in the lab, or develop work-flows to be implemented in the electronic medical record, let’s all work together, make sure we understand our role in the process, understand why we do something the way we do, and how our work impacts others. It is then that we have the greatest opportunity to achieve Best Care.

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They will never forget how you made them feel.

Donna Sollenberger, EVP & CEO, UTMB Health SystemI remember one year growing up in Springfield, Illinois, my uncle developed a chronic illness which, I believed and was wholeheartedly convinced, required a specialist. I attempted to persuade him to see a physician who specialized in his chronic condition. It would be easy, I told him, because I could arrange the appointment. However, my uncle declined. He wanted to stay with his current physician.

Not one to let things lie, I probed more closely. Why would he prefer to stay with his current physician and decline seeing the doctor that specialized in the chronic condition? His response interested me. He said that his current physician delivered a great quality of care for him. Why would he change now? So, I continued my probe.

How did my uncle know that his physician delivered great quality of care? His multi-faceted answer was even more insightful. It seems my uncle assessed the quality of care he received from his doctor in a way that most non-clinical people do, even today—they base it on the quality of their experience. To my uncle, a quality patient experience was about the following:

  • My doctor and his staff know me, so I can always get through when I contact them and get my questions answered or my needs met.
  • They always call me back within the day.
  • They are close to my home, so it is easy for me to drive there.
  • If I am sick, they always work me in that day.
  • Parking is easy and free.
  • My doctor’s office is new and pretty.
  • My doctor always has time to listen to me.

For a health care professional, it might seem odd that there is nothing in the above assessment regarding the training and experience of the physician, the access to other physicians for consultation, the way in which the chronic condition is managed so that it is under control—even in remission. There is nothing in his preferences about access to the best equipment, use of evidence-based guidelines in the patient’s treatment, or about the outcomes of other patients. My uncle’s entire assessment of the quality of his care was based solely on the experience he had as a patient visiting his physician. And yet, my uncle believed the quality of his care was outstanding.

Over the years, I have come to learn that the value of the patient experience cannot be underestimated. As a provider, we can do everything well in terms of the patient care delivered and the care interventions we make, but if the patient does not feel that they were treated with compassion and respect, or if they do not feel that we were responsive to their needs, or if they have trouble getting access to an appointment time that was convenient or timely for them, or if they felt they were not being listened to because the physician and/or staff never made eye contact with them or the conversation was rushed, the patient will not perceive that she or he is getting the quality of care s/he deserves. In short, the patient experience is crucial to the patient feeling as if they are receiving quality care.

In the past months, we have been focused on Best Care, which means we are upholding our unwavering commitment to deliver the right care, at the right time, in the right way, for the right person – and achieve the best possible results – for every patient, every time. One of the components of Best Care is patient-centered care, which means “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (Institute of Medicine, 2001).

Every employee at UTMB in some way impacts how well we perform in the areas mentioned above—whether that contribution is direct or indirect in terms of the patient. It is true, sometimes in a large organization like UTMB, an individual who doesn’t directly “touch” a patient might not immediately realize how what one does truly helps or impacts the patient. If you feel that way, just think of a line of people passing buckets of water from one to the other from a source of water to be poured into a large water tank. An individual in the beginning or middle of the line may not be able to see the end result (i.e., the water being thrown into and filling the water tank), but the contribution of the individual is indispensable to the final outcome.*

Every interaction a patient has with our system influences their experience!

At UTMB, we are dedicated to providing an exceptional experience with excellent outcomes to all patients, no matter who they are, what their background is, what age they are, what their gender, race or ethnicity is, or how much insurance coverage or ability to pay they may have—this is equity of care, another focus of Best Care.

So, what can each person at UTMB can do to contribute to the patient experience? The following are just a few easy things we can all do, but there are ultimately countless actions we can take, and I encourage you to think about how you make a difference in your own important role:

  • Always warmly greet and assist patients and visitors—and one another.
  • Treat all patients and visitors with respect.
  • Be aware when someone looks lost or confused and offer to help them to their destination or point them to someone who can assist.
  • Assure equipment, supplies and medications are available for all patients at all times.
  • Conduct timely equipment inspections.
  • Provide language interpreters and interpreters for the hearing impaired; you can receive certification to assist in this endeavor through language services.
  • Attend training to increase ability to care for diverse groups of patients.
  • Work in teams and as a team.
  • If your personal finances permit, contribute to programs like the UTMB Good Neighbor program.

There is a quote attributed to speechmaker Carl W. Buehner (and a few others) that says, “They may forget what you said—but they will never forget how you made them feel.” This can certainly be applied to the patient experience—whether you deliver patient care, respond to the patient’s concerns, ensure supplies and lab samples are delivered, help patients access our system, help them find the resources they need, or you create a warm, welcoming environment, you all contribute to the feeling of being well cared for at UTMB Health. I appreciate everything you do to create an excellent patient experience and to contribute to Best Care.


*Concept adapted from Grant Bright, Former Project Lead, IBM

**In addition to patient-centeredness and equity of care, the remaining areas of focus for Best Care include effectiveness of care, efficiency, patient safety and mortality, as measured by the Vizient Quality & Accountability Study.

Best Care Update

Donna Sollenberger, EVP & CEO, UTMB Health SystemAs you all know, we experienced a fire in John Sealy Hospital last week. Although some of our teams are now working in temporary locations until the hospital can be restored, we have resumed normal operations. So this week, I am again looking ahead to Best Care and what we need to do to assure that we will rank in the highest quartile of performance as measured by the Vizient Quality & Accountability Study.

We have done much work since June when we began working in earnest to improve outcomes of care for our patients. As a result of that work, we are starting to see improvements in our performance. We all remember that when we began the Best Care initiative, we ranked in the top 20 out of 102 academic medical centers in both equity of patient care (this means that our patients get the same care, regardless of their race, ethnicity, sexual orientation, economic status, etc.) and in patient-centered care.

Moving forward, we needed to remain a top performer in both of these categories, and to date, we have accomplished this. For example, our goal in patient-centeredness for the first quarter of the fiscal year was to have 76.4 percent of our patients rate us on the patient satisfaction survey as a nine or ten (on a scale of one to ten) for their overall experience of care. And there’s good news—for the first quarter of FY17, 81.6 percent of our patients rated us at the top of the scale! This is excellent work, and we need to keep it up!

Our work to increase patient safety has also been exceptional. For this measure, we use a rating called the Patient Safety for Selected Procedures Composite Score (a measure developed by the Agency for Healthcare Research and Quality), otherwise known simply as PSI-90. Patient Safety Indicators (PSIs) reflect the quality of care inside hospitals, but focus on potentially avoidable complications and adverse events following surgeries, procedures and childbirth. These types of events include, but are not limited to, the rate of pressure ulcers, falls in the hospital resulting in hip fracture, the rate of hemorrhage or hematoma after surgery, and the rate of postoperative sepsis (a severe bloodstream infection resulting in decreased organ function). We are doing exceptionally well with this measure. Our target score for the first quarter was 0.91 and we scored 0.65 (lower numbers are better, in this case). Our target for next quarter is 0.80, so we need to keep up this excellent work and do all we can to do even better!

For preventable readmissions within 30 days of discharge, we exceeded our first quarter target of 13.6 percent—our performance was 12.5 percent (again, lower numbers are better). This means that we did a good job of managing our patients once they left the hospital, we followed up with them to make sure they were following their care plan, and/or we managed their health in our clinics so they did not come back to the hospital within the 30-day time frame. While this is excellent work, we increase the challenge to meet our targets each quarter so that we have to continually improve. For the next quarter, our goal for the 30-day all-cause readmission rate is set at 12.58 percent or less, so we have to keep improving!

We also met our goal to reduce our mortality rate, which is described as a ratio that compares how many patients passed away, in total, compared to how many were expected to pass away while in the hospital based on how sick they were. A significant part of the effort to improve our rate has been rooted in clinical documentation improvement, because the more specific the documentation is, the more accurately the patient’s severity of illness is reflected. Additionally, if we do not document the care we deliver to our patients well enough, our performance appears worse than it actually is—even if the care was excellent and the patient had a good outcome. To help support our providers in this endeavor, we have been working to optimize our electronic medical record (Epic), and we are also offering documentation training to physicians on our inpatient units—for example, providers should not use symbols when documenting, and it is important to use special and specific wording when describing the patient’s condition.

For the mortality score, a score of less than 1 means that more patients survived than were predicted to. A score of more than 1 means that more patients passed away than were predicted to. So, a lower score is better. This quarter, our mortality observed/expected rate was 0.91, where our target was 0.99. Since lower numbers are better, this means we met our goal. For the next quarter, however, our target is 0.90, so we have some more work ahead of us.

The last major measure we are tracking is length of stay (LOS). This falls under the Vizient Quality & Accountability Study’s category of Efficiency, which measures how well we are using our resources compared to how ill the patient is. This measure is case mix index adjusted, which essentially means that it takes into consideration the diversity, clinical complexity and resources needed to care for our total hospital patient population. Our goal for this first quarter’s LOS at the Galveston campus was 2.85 days. At 2.96 days, we missed our goal. We have a significant amount of work to do, because for next quarter, our goal will be 2.81 days.

I know many of you have asked me how we are doing when it comes to achieving Best Care. If I were to summarize, I’d say we are on the right track and moving in the right direction. But to meet the goals we have for the end of this fiscal year, we have stay focused and maintain our absolute resolve to meet our Best Care goals.

I want to thank each of you for our improvements made since June. I know this requires a lot of work, but if we can make these improvements stick, ultimately, our work will become easier. And even more importantly, our patients will receive the Best Care.

bestcareperformanceq1

*Lower numbers are better

Everyday Heroes

Donna Sollenberger, EVP & CEO, UTMB Health SystemMost of you already know that I was not here for Hurricane Ike. I arrived to work at UTMB one year and a day afterward. My first day of work at UTMB, I remember standing in the grassy area in front of John Sealy Hospital during the Hurricane Ike Commemoration Ceremony. Dr. Callender was surrounded by a small group of employees who listened to him talk about the progress the organization had made over the past year, and he reflected on the experiences of the first days after the storm. He recalled the extraordinary effort of some of our facilities colleagues who made sure the UTMB sign on John Sealy Towers was lit. Then, the ceremony ended, and the UTMB flag was raised by two of our students. I stood at the back of the small crowd, listening and watching the emotions of the people there. It was obvious that the memories of this experience were still quite vivid and emotions were still raw. There was still much healing to be done.

About two years ago, UTMB had the opportunity to host the University of Texas System Board of Regents and members of UT System leadership at a dinner reception. That evening, Dr. Joan Richardson, chair of the Department of Pediatrics, spoke of her love of heroes when she was a girl. She told us that she had always wanted to know a hero, but had not had a chance to know one—that is, until September 2008. As she described the work of hundreds of people who rode out the storm and the many others who came back to work tirelessly to reopen UTMB, she said that she realized she knew hundreds of heroes. They came from every walk of life, and they all had one thing in common—their resolve to reopen UTMB. UTMB stopped for no storm.

I remember the absolute silence that evening as the audience sat mesmerized at the story of the heroes at UTMB. There were few dry eyes in the room when Dr. Richardson finished her story. I remember thinking how lucky I was to work with people who made sure that UTMB, like the mythical phoenix, rose again from Hurricane Ike’s devastation.

Houston Fire Department to the rescue!

Houston Fire Department to the rescue!

This past Wednesday, I experienced what Dr. Richardson described. I was walking toward the Administration Building on the Galveston Campus when I saw a fire truck and two escort cars arrive in the front of John Sealy Hospital. It is not unusual to see an emergency vehicle or two in front of the hospital from time to time, and it generally is not a serious issue. But as I watched two of our police officers run past me and into the east entrance of John Sealy Hospital, I realized something serious was happening. Within minutes, we learned that a fire, yet uncontained, had broken out on the second floor and that smoke was in the stairwells and moving throughout the building. We declared an emergency at UTMB.

Transportation staff in action

UTMB Transportation staff in action, waiting in front of Jennie Sealy Hospital to transfer patients.

Working with local fire departments, a decision was made to evacuate the 110 patients, their visitors and our staff in John Sealy Hospital. Although this was an intense situation, our staff, physicians and managers remained calm and focused on getting everyone out of the building. As the patients were being safely transferred out of the building, we simultaneously needed to decide on where to place the patients. Administrators, doctors and managers worked together under pressure to identify the best places to continue care for our patients in our care facilities. I applaud every one of you who helped moved our patients to new locations, got them settled in, and worked to assure that their needs in these new areas were met. It was a challenging situation, but everyone problem-solved and worked together to get what was needed to help our patients.

A hero is defined as someone who makes a personal sacrifice in order to benefit others or someone who is noted for their courageous action. I now know from my own personal experience what it is like to work with hundreds of heroes. To everyone who made the safe evacuation of 110 patients possible on Wednesday, you are the heroes of UTMB! Thank you for the personal sacrifice and the risks that you took to benefit so many others!

Thank you to the Galveston Firefighters, the Galveston County Health District EMS, the Galveston Police Department, Island Transit, the Houston Fire Department, and Santa Fe Fire & Rescue for coming to UTMB’s aid!